Nokea
Puerperal pyrexia is characterized by any episode of fever during the entire puerperium.
- A. TRUE
- B. FALSE
- C. -
- D. -
Correct Answer: B
Rationale: Puerperal pyrexia is defined by persistent fever, not any episode during puerperium.
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In marginal cephalopelvic disproportion,
- A. All the patients will need an operative delivery.
- B. Half of the patients will need an operative delivery.
- C. The problem is always overcome during labor.
- D. The pelvis is too small for the fetus to pass through.
Correct Answer: C
Rationale: Marginal cephalopelvic disproportion can often be managed in labor without the need for a cesarean.
Based on vaginal examination findings, indicators of abnormal labor are
- A. Bandl’s ring and oedematous vulva
- B. Oedematous cervix and fetal hypoxia
- C. Hot, dry vagina and arrest in descent
- D. Maternal distress and severe moulding
Correct Answer: C
Rationale: A hot, dry vagina and lack of descent suggest abnormal labor patterns.
The neonatal birth injury that results due to bleeding between the epicranial aponeurosis and the periosteum is
- A. Caput succedaneum
- B. Intracranial hemorrhage
- C. Subgaleal hemorrhage
- D. Aponeurotic hemorrhage
Correct Answer: A
Rationale: Caput succedaneum is caused by bleeding between the epicranial aponeurosis and the periosteum.
The AGACNP is treating a patient with ascites. After a regimen of 200 mg of spironolactone daily, the patient demonstrates a weight loss of 0.75 kgday. The best approach to this patients management is to
- A. Continue the current regimen
- B. D/C the spironolactone and begin a loop diuretic
- C. Add a loop diuretic to the spironolactone
- D. Proceed to large-volume paracentesis Which of the following is a true statement with respect to the use of corticosteroids in posttransplant patients?
Correct Answer: B
Rationale: The best approach to managing the patient with ascites who has responded to spironolactone with weight loss is to add a loop diuretic to the current regimen. Spironolactone is an aldosterone antagonist that primarily works on the distal convoluted tubule, while loop diuretics, such as furosemide, act on the thick ascending limb of the loop of Henle. Combining these two diuretics can result in a synergistic effect, increasing diuresis and reducing fluid retention in patients with ascites. This combination therapy is often used in patients who do not respond adequately to spironolactone alone, and it is considered a common strategy in the management of ascites due to cirrhosis. Therefore, adding a loop diuretic to the spironolactone regimen is the most appropriate next step to optimize diuresis and fluid management in this patient.
P. T. is a 58-year-old female who is admitted with chest pain and shortness of breath and is found to have a large pulmonary embolus. Her systolic blood pressure is falling, and a diagnosis of obstructive shock is made. Cardiac pressure would likely demonstrate
- A. Elevated atrial and decreased ventricular pressures
- B. Elevated right-sided and decreased left-sided pressures
- C. Elevated left ventricular pressure and decreased cardiac output
- D. Elevated left ventricular pressure and decreased systemic vascular resistance
Correct Answer: B
Rationale: Obstructive shock, such as in this case of a large pulmonary embolus causing obstructive shock, results in a sudden increase in right ventricular afterload due to obstruction of blood flow. This leads to right heart failure and decreased left ventricular preload, ultimately resulting in decreased cardiac output. The elevated right-sided pressures will be reflected by elevated right atrial and ventricular pressures, while the left ventricular pressures will be decreased due to decreased preload. This commonly leads to a situation known as acute cor pulmonale, where the right heart becomes dilated and dysfunctional in response to the increased afterload.